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CARDIOVASCULAR TREATMENT

Primary PCI for STEMI

Definition

  • STEMI is ST Elevation Myocardial Infarction. A type of myocardial infarction (heart attack) with characteristic ST elevation on electrocardiogram.
  • PCI is Percutaneous Coronary Intervention.
  • Primary PCI is the PCI without pharmacologic intervention before PCI procedure except those given during PCI procedure.
  • Direct admission: Patients who received the STEMI diagnosis at the PCI hospital.
  • Transferred admission: Patients have STEMI diagnosis at other (First-non PCI) hospital then transfer to PCI hospital.
  • “Door to Balloon time” is counting from FMCFirst Medical Contact – when the diagnosis of STEMI was made, to the time start using device to open the occluded coronary artery.
    • For direct admission: Door to balloon time should be
    • For transferred admission: Door to Balloon time should be

  Primary PCI vs Thrombolytic treatment for STEMI.

  • In case of STEMI, it has been established that primary PCI that can be accomplished within the time frame as indicated above is better than thrombolytic treatment.

  Bangkok Heart Hospital Primary PCI for STEMI program

  • Acute Myocardial Infarction management program at Bangkok Heart Hospital has been certified by Joint Commission International 2008.
  • Direct admission result
           Primary PCI for STEMI for direct admission patients at Bangkok Heart Hospital, 2012-2014
    • Consecutive cases that have the initial diagnosis at Bangkok Heart Hospital 
    • During this period we have not used thrombolytic treatment as an initial reperfusion therapy
    • “Door to Balloon time”, with cases exclusion per ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction, as in the table below
 Number of case 33
 Median door to balloon time 84 Minutes
 Percentage of median door to balloon time less than 90 Minutes 60.6%
 
  • Transferred admission program To achieve Primary PCI for STEMI for transferred patient ( less than 120 minutes) is very difficult or not possible in Bangkok-Thailand
  • Encouraging “Pharmaco-invasive” approach
    • Thrombolytic therapy in 30 minutes in the first (non PCI) hospital 
    • Transfer to Bangkok Heart Hospital
    • Coronary angiogram-PCI in 3-24 hours from thrombolytic treatment time
  • Transfer to Bangkok Heart Hospital for Rescue PCI, Late or Delay PCI.